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Specialties

Arthroscopy

Arthroscopic surgery, or arthroscopy, is a minimally invasive procedure to view, diagnose and treat problems inside a joint. Premier surgeons can directly view the joint using a high-tech camera instrument called an arthroscope. The arthroscope has revolutionized the field of orthopaedic surgery, especially in the care of sports and recreational injuries. It allows surgeons to directly visualize the interior of a joint via access through very tiny (keyhole-sized) incisions, and address torn or damaged structures that require repair or reconstruction.

Arthroscopy has significantly enhanced the quality of orthopedic care available to patients by allowing surgeons to perform the most modern and advanced techniques.  A wide variety of conditions that previously required larger, more painful incisions and a longer time for recovery can now be performed with less discomfort and inconvenience to the patient.  Recovery time is shorter and the incisions are more cosmetic due to their small sizes.

If appropriate for your condition, arthroscopic surgery can be performed for your knee, hip, ankle, wrist, elbow or shoulder. Arthroscopy can treat and relieve a variety of conditions including:

  • KNEE
    • Anterior cruciate ligament (ACL) tears of the knee
    • Posterior cruciate ligament (PCL) tears of the knee
    • Meniscus tears and baker’s cysts
    • Loose cartilage bodies or osteochondral defects/injury
    • Synovitis and joint inflammation
    • Tibial spine fractures
  • SHOULDER
    • Instability: labral tears and shoulder dislocation
    • Rotator cuff tears and strains
    • Impingement syndrome and bursitis
    • Bone spurs and calcific tendonitis
    • Biceps tendonitis and tears
    • Greater tuberosity fractures
  • HIP
    • Femoroacetabular impingement (FAI) – “hip impingement”
    • Labral tears
    • Athletic groin pain and joint inflammation
    • Snapping hip syndrome
    • Gluteus medius/minumus tears
    • Iliotibial band syndrome
    • Cartilage injuries or loose bodies
  • ELBOW/WRIST/HAND
    • Elbow loose bodies/arthritis
    • Osteochondral injuries
    • Tennis Elbow (Lateral epicondylitis)
    • Carpal tunnel surgery
    • TFCC Tears of the wrist
    • Ganglion cysts

KNEE ARTHROSCOPY

The arthroscope was first used in the knee, and even today, the knee remains the most common joint for the surgery.  In addition to documenting the source of your knee problems, much can be done therapeutically for the knee via arthroscopy.

Each knee contains two C-shaped cartilage shock absorbers known as menisci.  The menisci are frequently torn and can be arthroscopically repaired or removed, depending on the type and location of the tear.  Only the torn portion is removed, leaving the remainder to continue to act as an important shock absorber.  In some instances of complete meniscus removal, especially in younger patients, a completely new meniscus can be transplanted.

The joint surface covering or cushion can become damaged or injured or worn out, as commonly occurs with arthritis. Newer techniques and technology can be used to regenerate focal areas of joint cushion damage, hopefully preventing future arthritis.  Also, although arthritis cannot be fixed with arthroscopy, in selected cases, sometimes arthritic knees can be improved if there are significant symptomatic meniscal tears present or other treatable abnormalities.

A more recent advancement in knee arthroscopy involves the repair and/or replacement of certain internal ligaments within the knee.  The anterior and posterior cruciate ligaments are important stabilizing ligaments that are commonly torn in athletes and active individuals.

Especially in the case of the anterior cruciate ligament (ACL), such a tear results in a “trick knee” that can buckle without warning, and easily be reinjured especially with sports.  Although some individuals with this condition improve with rehabilitation alone, many have ongoing instability problems requiring surgical reconstruction of the ACL.  This is especially true for active younger individuals who rarely can be managed successfully without ACL reconstruction.  Arthroscopic techniques have improved the procedure greatly and allow the major portion to be done arthroscopically.  Small incisions are still required to either harvest or insert the new ACL graft into the knee.  This procedure has allowed a much quicker recovery, less pain and easier rehabilitation of this very common condition.

SHOULDER ATHROSCOPY

Arthroscopic techniques in the shoulder are similar to that in the knee in many ways.  In the shoulder, the glenoid labrum, an important stabilizer (similar to the meniscus and the knee), is sometimes torn.  It can be repaired or removed.  Shoulder instability can also be fixed arthroscopically.

The rotator cuff muscles, which are involved with shoulder strength and mobility, are prone to fraying, inflammation and also tears.  When they are irritated and pinched, the ailment is known as impingement syndrome.  The arthroscope can be used to repair rotator cuff tears and remove any impinging tissue.

HIP ARTHROSCOPY

The hip joint is made up of the hip socket called the acetabulum, the ball portion of the joint called the femoral head, and an important section of collagen called the labrum which acts as a protective bumper around the joint. The surfaces of the joint are also covered in smooth cartilage which acts as a cushion when standing, walking or running. Loss of this protective layer of cartilage may lead to premature arthritis of the hip, which ultimately requires a hip replacement.  However, if identified early, injury to the labrum and cartilage tissues can be addressed with hip arthroscopy which may help relieve pain and prevent or slow down the development of arthritis.

Hip Arthroscopy, sometimes referred to as a “hip scope,” is a minimally invasive hip surgery in which an orthopedic surgeon uses the latest technology and small fiber-optic cameras to address many causes of hip and groin pain in young athletes by looking directly into the hip joint.

The problems typically addressed with a hip scope include: hip labral tears, cartilage injuries, loose bodies/cartilage fragments, and femoroacetabular impingement (FAI), abductor tears and iliotibial band syndrome.  Athletic patients with hip impingement or labral tears may experience symptoms such as: pain with running or prolonged sitting, popping or clicking in the hip, groin pain with deep flexion. Prior to the recent development of these arthroscopic methods, surgery for these conditions required extensive muscle dissection and a long incision. Now the same pathologies can be addressed through 2 or 3 keyhole sized incisions which makes the recover easier, faster, and typically less painful.

ELBOW, ANKLE & WRIST ARTHROSCOPY

In the elbow and ankle, the most common arthroscopic procedure involves the removal of impinging bone spurs and loose bodies or bone chips.  Also, problems with the joint surface can be evaluated and addressed, similar to what is done and the knee.  Tendon issues such as tennis elbow and golfer’s elbow can also be managed.  In the ankle, torn ligaments can be tightened to manage instability or recurrent sprains. The wrist contains a small triangular fibrocartilage that is often torn in a fall on the outstretched hand.  This too can be repaired, or removed if necessary, through the scope.

If you are interested in finding more whether arthroscopic surgery can help your condition, please schedule an appointment with a Premier Orthopaedic Surgeon.

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Complex Fracture Care

Complex fractures in adults occur when
 a bone is broken and causes damages surrounding soft tissue and cartilage. Complicating the issue, these injuries are often irregular and can be different with every patient. At Premier Orthopaedics, our surgeons are committed
 to providing dedicated one-on-one care and have extensive experience in developing individualized treatment plans.

When you choose Premier Orthopaedics, you’re choosing the best complex fracture and trauma reconstruction doctors in the area. Many of our doctors have more than 20 years of experience in orthopaedic surgery, specializing in either athletic or adult treatment. Our experienced and compassionate physical therapists are dedicated to returning patients back to their pre-injury activity level as quickly as possible.

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Concussion

Our certified impact consultant physicians and athletic trainers will help get you back in the game in a safe and timely fashion. The focus of Premier's concussion program is to educate and assist athletes, parents and coaches in the proper identification and management of concussions. We utilize a neurocognitive assessment tool and comprehensive management services to allow our certified impact consultant physicians, physical therapists and athletic trainers to guide the recovery of the concussed individual, providing a safe return to play.

Program Components include:

  • Education and awareness for coaches, parents, athletes and others
  • State-of-the-art computerized neurocognitive assessment tools to ensure every patient is evaluated using the best technology available today
  • Concussion assessment and physical examination by our experienced, knowledgeable concussion providers
  • Physical therapy including balance and vestibular function
  • Guided return to play. Decisions with reintroduction steps to get athletes back to play as soon and as safely as possible

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Foot & Ankle

Nothing impedes everyday life like excruciating foot pain. Premier’s renowned team of foot and ankle specialists have helped hundreds of people suffering from foot pain get back on their feet in no time.

At Premier Orthopaedics, treatment options include everything from physical therapy to necessary surgeryall under the guidance of experts in the field of foot and ankle pain. Premier Orthopaedics even offers its patients orthopaedic urgent care in the event of an accident or emergency.

Some foot issues can be a painful nuisance. These include diagnoses such as:

    • Achilles tendon issues (bursitis, tendonitis, tendinosis, rupture)
    • Ankle arthritis (primary or post-traumatic)
      • Ankle fusion
      • Ankle replacement
    • Ankle injuries
      • Ankle fractures
      • Ankle sprains
      • High ankle sprains
    • Athletic injuries
    • Arthroscopy of the foot or ankle
  • Bunions / Bunionettes (Tailor’s Bunion or bunion of the 5th toe)
    • Cavus foot (high arch foot)
    • Flatfoot (fallen arches)
    • Foot arthritis
    • Foot pain
    • Fractures
  • Great toe arthritis (Hallux limitus or rigidus aka stiff big toe)
  • Hammertoes and claw toes
  • Heel spur (plantar OR posterior heel bone)
  • Lacerations
  • Lateral ankle instability
  • Ligament injuries
  • LisFranc injuries (dislocation / fracture)
  • Nerve injuries
  • Neuromas (injection, decompression, excision)
  • Osteochondral lesions of the talus (ankle cartilage damage)
  • Painful hardware
  • Plantar plate tears
  • Pediatric issues
  • Posterior tibial tendonitis
  • Rheumatoid arthritis
  • Soft tissue tumors (ganglions, fibromas)
  • Sports medicine
  • Stress fractures
  • Tarsal tunnel
  • Tendon injuries (tendonitis, tendinosis, tears)

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Hand & Wrist

Hand and wrist discomfort is something most of us experience at one time or another. While most hand or wrist pain is temporary, some pain can be indicative of a permanent issue requiring expert medical care.

One of today’s most well known hand and wrist problems is carpal tunnel syndrome. Symptoms can often include tingling and numbness of the hand and wrist, and may also be accompanied by shooting pains up the arm. Left untreated, carpal tunnel can strain wrist tendons to the point where just holding something is difficult – not to mention painful. Diagnosing the problem and getting treatment early is extremely important in order to avoid permanent damage.

If hand pain becomes serious for you, or someone you love, Premier Orthopaedics renowned team of physical therapists, surgeons and doctors are at the ready to provide the experienced hand and wrist care you deserve.

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Hip

Although fairly common, hip pain can turn even the most routine moments into an uncomfortable experience. Some hip discomfort is minor enough that only easy home remedies such as exercise, weight loss or simple rest are needed. As the body ages, however, hip pain can be a sign of arthritis, bursitis or a problem with the actual hip joint.

Whether your hip pain was caused by a sporting accident, aging or disease, it’s best to seek out the help of an experienced orthopaedic specialist to develop a proper course of treatment. If, and when, it’s decided a hip replacement is the right solution, a prosthetic implant will be necessary to replace the hip joint.

For men and women throughout the region who’ve decided that a hip replacement is their best option, Premier Orthopaedics is often the provider of choice for their surgery. That’s because more Delaware 
and Chester County men and women turn to Premier for long-lasting solutions to painful hip and joint problems than anywhere else.

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Interventional Pain Management

When pain begins to stand in the way of your life, it may be time to seek out the help of experienced physicians—like the ones you’ll find at Premier Orthopaedics. Many of Premier’s physicians have over 20 years of experience in their respective specialties, and all are committed to providing the community-based medicine needed to keep our neighbors on the move.

The first step in making this goal possible is figuring out the source of your pain. Utilizing dedicated musculoskeletal MRIs, cutting edge ultrasound techniques and electromyography and nerve conduction studies (EMG/NCS), to detect anything from the slightest pinched nerve to complex fractures, Premier’s fellowship-trained specialists can accurately pinpoint the cause and create a treatment plan.

In cases where surgery isn’t the first option for pain relief, or the patient has completed surgery and is now facing rehabilitation, a non-surgical treatment plan—which may include therapeutic outpatient procedures—is often developed.

If acute and chronic overuse sports injuries or painful orthopaedic conditions affecting the spine, muscles and joints have you in pain… count on the specialists at Premier to get you back to the game of life.

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Joint Replacement

Joint pain typically occurs because cartilage, the protective cushion between bones, becomes brittle over time. As cartilage disintegrates, bones can begin to rub together during exercise or other activities, resulting in pain and discomfort.

To treat this condition, an orthopaedic surgeon can perform joint replacement surgery to replace part, or all, of the joint. Joint replacement surgery is one of the leading surgical procedures for aging members of the populationparticularly for those individuals who have tried various non-surgical treatment options, yet are still experiencing measurable pain when trying to participate in favorite activities. Joint replacement is a safe and reliable procedure that allows many patients to return to exercise, sports and other activities after a period of recovery.

From hip and knee replacements, to ankle, wrist, shoulder and elbow replacements, Premier’s specialists have the knowledge, facilities and tools to provide patients with a safe and pain-free return to everyday activities. If you think joint replacement may be the answer to your discomfort, do what so many other Delaware and Chester County residents do… look to Premier for help. Our experienced physicians will work with you one-on-one to explain the risks, benefits and expected outcomes associated with surgery related to your specific condition.

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Knee

Knee pain can affect a person at any
 stage in their life. Whether it's due to arthritis, old age or a past knee injury, many knee problems can be managed conservatively with rehabilitation, exercise, medication and injections. But for those experiencing severe and ongoing stiffness, locking and popping knee pain when walking, climbing stairs or participating in other activities, knee replacement surgery may be necessary.

If you think you’re a good candidate for knee surgery, look to Premier for the care you’ll need to get back on your feet as quickly as possible. Our team of surgeons—highly skilled in performing the latest minimally invasive procedures including arthroscopy and ACL reconstructions—are among the regions most skilled at knee replacement surgery.

Of course, before any procedure is undertaken, Premier’s fully licensed knee specialists first perform an evaluation to determine whether or not knee surgery is indeed the appropriate solution for you. During evaluation, they’ll explain to you the realistic expectations for recovery times and activity after surgery, as well as answer any questions you may have.

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Non-Operative Rehabilitation

Not every orthopaedic condition or injury stemming from trauma, age or overuse, results in surgery. Non-surgical rehab is a course of treatment that aims to relieve pain and restore function without surgery. This type of treatment has successfully reduced pain related to on-the-job injuries, sports injuries, auto accidents, lower back disorders, pelvic issues and problems related to the head and neck. Even old musculoskeletal injuries can benefit from this type of rehabilitation.

Pediatric patients with birth-related conditions can also benefit from non-operative rehabilitation. Some of the treatments we offer include bracing, casting and physical therapy tailored for children. In conjunction with these, or any non-surgical treatment, physical therapy may also be utilized to aid in the healing process. These therapies may include medication, the cessation of activity or daily exercise—all conducted in a convenient outpatient setting,

Premier Orthopaedics’ non-operative rehabilitation team is skilled in diagnosing and treating disorders related to the bones, joints, muscles, back, neck and nerves, without the use of surgery. Armed with today’s most advanced techniques and non-operative procedures, Premier’s specialists have helped improve the lives of hundreds of area patients.

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Osteoporosis Care

In a patient with osteoporosis, the bones become weak and prone to breaking from anything from everyday activities to minor falls. As you age, bone mass, which typically peaks when you’re in your twenties, is lost faster than it can be created.

Osteoporosis doesn’t cause any noticeable symptoms, so many people don’t know that they’re actually living with the disease and often it only becomes apparent once the patient has a fracture. Some subtle symptoms of osteoporosis include back pain, loss of height over time and a stooped posture. Osteoporosis causes fractures to occur even after minor injuries—typically occurring in the spine, wrist and hip.

If you’ve recently suffered a fracture from a minor injury or think you may be dealing with osteoporosis, a dual energy X-ray absorptiometry, or DEXA, is the best way to determine whether you have osteoporosis. Measured at different areas of your body, such as the spine and the hip to establish mineral density, DEXA is painless and only takes about 10 to 20 minutes to perform.

After diagnosing your condition, Premier physicians will start your treatment, working with you closely every step of the way to effectively manage your osteoporosis.

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Podiatry

With the 26 bones in the human foot (one-quarter of the bones in the human body), approximately 33 joints, and over 100 tendons, muscles, and ligaments, all working together to provide the body with support, balance, and mobility, problems do arise. That’s why at Premier we have a team of podiatrist to handle a wide array of foot and ankle conditions.

Podiatrists, also known as foot and ankle doctors or surgeons, are medical specialists who underwent dedicated training to the study of medical issues of the foot, ankle, and heel. Common issues they treat are related to skin and nails (growths, lesions, corns/calluses, ingrown or fungal toe nails), structural issues (flat or high-arched feet), tendon or ligament pain (plantar fasciitis, Achilles tendinitis), gout, foot arthritis, diabetic evaluation and preventative management, and sports medicine (sprains, fractures).

Our podiatrists employ both conservative, non-operative and operative treatment for the conditions below as indicated:

  • Bunions / Bunionettes (Tailor’s Bunion or bunion of the 5th toe)
  • Bursitis of the foot or ankle
  • Crossover digits
  • Corns and calluses
  • Diabetes issues (nail fungus, sores, screening)
  • Flatfoot (fallen arches) or high-arched foot
  • Foreign bodies (stepped on items – glass, needles, etc)
  • Gangrene
  • Gout
  • Great toe arthritis (Hallux limitus or rigidus aka stiff big toe)
  • Hammertoes
  • Heel Spurs
  • Ingrown toenails
  • Neuromas
  • Onychomycosis (toe nail fungus)
  • Orthotics
  • Pediatric issues
  • Plantar plate tears
  • Plantar fasciitis
  • Rheumatoid arthritis
  • Tinea Pedis (athletes foot)
  • Ulcers due to diabetic foot problems
  • Xerosis (dry skin)

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Regenerative Medicine

The physicians at Premier Orthopaedics offer cutting-edge treatments for orthopaedic conditions and utilize the most advanced Regenerative Medicine (Stem Cell Therapy) treatments for patients.

The physicians at Premier Orthopaedics offer cutting-edge treatments, both surgical and non-surgical, for orthopaedic conditions and utilize the most advanced Regenerative Medicine (Stem Cell Therapy) treatments for patients.

These treatments use a patient’s own cells to address painful spine conditions, osteoarthritis, soft tissue (tendon, ligament and muscle) and cartilage damage. We utilize Platelet Rich Plasma (PRP) treatments, Bone Marrow Aspirate, Prolotherapy and LipogemsTM, which was awarded one of the Eleven Best Sports Medicine Technologies for 2016 by Orthopedics This Week. Surgical techniques include microfracture, Autologous Chondrocyte Implantation (ACI) and MACI, the newer scaffold based cell therapy for knees. The goal of these regenerative treatments is to improve your quality of life after an injury or natural degeneration, using your body’s own cells to stimulate healing.

Platelet Rich Plasma (PRP) Therapy

A component of your blood, called platelets, has large reservoirs of proteins called growth factors, which initiate and accelerate tissue repair and regeneration. PRP is concentrated blood plasma with many more platelets than what is typically found in blood. The concentration of platelets —and, thereby, the concentration of growth factors —can be 5 to 10 times greater than usual. The injection if this product into a damaged area promotes tissue repair.

Prolotherapy

Prolotherapy involves the injection of a stimulating substance (usually dextrose/sugar) to trigger the body’s intrinsic ability to heal an injury that incompletely resolved or a repetitive stress that is beyond self repair —it is usually focused at the weakened points of tendon or ligament attachments to bone.

Lipogems ™

Lipogems™ is a gentle process that uses your body’s own fat tissue to cushion and support areas of injury or damage as your body heals itself. Fat is rich in regenerative cells, growth factors and cytokines, it is especially effective for areas where there are soft tissue defects.

Bone Marrow Aspirate Concentrate

This minimally invasive procedure is done under local anesthesia to harvest bone marrow and utilize your own bone marrow regenerative cells to repair an injured area.  It is best for patients with moderate to severe arthritis and other orthopedic injuries, due to the rich reservoir of regenerative cells contained in bone marrow.

Surgical Regenerative Options:

Combining surgical procedures with regenerative medicine is an ideal way of optimizing treatment results. The goal is to use your own cells to promote regeneration of damaged tissue and structures. Regenerative medicine aims to develop new treatments that canwill replace, repair, or promote tissue regeneration.

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Rheumatology

Rheumatic conditions such as arthritis 
and autoimmune disorders can affect joints, muscles, bones and some internal organs, causing debilitating joint pain for many. If you are dealing with a rheumatic problem, a rheumatologist who is knowledgeable about the unique aspects of joint disorders and other rheumatic problems can coordinate your care to achieve optimum wellness.

After an assessment of a condition is made, any one of a number of treatments may be recommended to treat a rheumatic condition including surgery, orthopaedic aids and medication. Because rheumatic problems require long-term management, patients may experience many different treatments with a variety of aids. It’s vitally important to choose a rheumatology program with the skill and training needed to provide you with customize care your particular lifestyle requires.

At Premier Orthopaedic and Sports Medicine, we can help you find a rheumatologist who’ll work with you to expertly manage your condition. Premier rheumatologists have diagnosed, treated and managed these often-complex issues for patients throughout the Philadelphia region.

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Shoulder & Elbow

Although it’s the most flexible joint in the human body and powers all arm movement, the shoulder is surprisingly delicate. Shoulder problems can have a major impact on your everyday activities, particularly if you're involved in any kind of athletics. Common shoulder injuries include strains, sprains, separations, fractures and dislocations, and can be a contributing factor in conditions such as tendonitis, bursitis and arthritis.

If you’re experiencing pain in your shoulders, arms or upper back, you shouldn’t ignore it, since it can be a major indicator of many types of problems.

Trained and experienced in everything from shoulder and elbow surgery to rehabilitation, Premier’s shoulder specialists offer a full range of treatment options for shoulder pain and injuries. With over 50 physicians and surgeons specializing in sports injuries and orthopaedic problems, many of our doctors have affiliations with professional dance companies, Olympic teams, collegiate athletic programs and pro teams.

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Spine

Responsible for carrying signals from the brain to other parts of the body, the spine is a critical part of the body and important to all daily activities. While minor spine problems can cause persistent back pain, major spinal cord injuries can have much more serious implications.

Whether you’re dealing with minor back pain or persistent back pain, that can be a sign of acute and chronic spine-related conditions, you want a spine doctor on your side who can help you manage the pain, repair the damage, and regain complete and comfortable range of motion.

Premier’s fellowship-trained physicians offer a variety of diagnostic and non-operative procedures in a convenient, easy-to-access outpatient setting. No matter what specialty or type of pain or injury you are dealing with, our physicians can help guide you on your way to recovery.

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Sports Medicine

As an athlete, it's important to keep your body in top shape. But all-too-often the very activities that keep you fit can also cause problems with your physical health. Sports medicine is a specialized branch of medicine dealing with the treatment and prevention of injuries related to sports and athletic activities.

Doctors who specialize in sports and exercise medicine are uniquely trained to handle all types of sports injuries, allowing them to treat problems related to ligaments, tendons, muscles and bones. In addition to treating athletic injuries, sports medicine specialists can also help you manage long-term conditions affecting your physical performance. If you’re suffering from conditions such as diabetes or asthma, unique precautions need to be taken when you’re physically active to stay in prime condition.

At Premier, our sports medicine physicians are skilled in the prevention and treatment of a wide variety of sports, fitness and exercise-related injuries and ailments. Whether you’re a professional athlete or just a weekend warrior, at Premier our priority is to not only get you back to the sports you enjoy as quickly as possible, but also through proper rehabilitation, prevent future problems as well.

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In August 2015, I had my right hip replaced by Dr. Cheston Simmons at Premier. At every step in the process, I felt I was receiving thorough, professional, and well-coordinated care.

~ Daniel Loose, West chester PA

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ABOUT PREMIER ORTHOPAEDICS

Premier Orthopaedics is the largest orthopaedic group in Delaware and Chester counties. Premier provides patients with the full spectrum of orthopaedic services; including bone, muscle and joint care. Patients trust our specialists for their experience, expertise and commitment to exceptional patient care.

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